Surgical Outcomes for Early-Stage Non-Small Cell Lung Cancer at Facilities with Stereotactic Body Radiation Therapy Programs.

BACKGROUND: Patients undergoing surgery for early-stage non-small cell lung cancer (NSCLC) may be at high risk for post-operative mortality. Access to stereotactic body radiation therapy (SBRT) may facilitate more appropriate patient selection for surgery.

RESEARCH QUESTION: Is post-operative mortality for early-stage NSCLC lower at facilities with higher utilization of SBRT?

STUDY DESIGN AND METHODS: Patients with early-stage NSCLC reported to the National Cancer Database between 2004-2015 were included. Utilization of SBRT was defined by each facility's SBRT Experience (years) and SBRT-to-Surgery Volume Ratios. Multivariable logistic regression was used to test for the associations between SBRT utilization and post-operative mortality.

RESULTS: The study cohort consisted of 202,542 patients who underwent surgical resection of cT1-T2N0M0 NSCLC. The 90-day post-operative mortality rate declined during the study period from 4.6% to 2.6% (p < 0.001), the proportion of facilities that utilized SBRT increased from 4.6% to 77.5% (p < 0.001), and the proportion of patients treated with SBRT increased from 0.7% to 15.4% (p < 0.001). On multivariable analysis, lower 90-day post-operative mortality rates were observed at facilities with greater than six years of SBRT Experience (OR 0.84, CI 0.76-0.94, p = 0.003) and SBRT-to-Surgery Volume Ratios above 17% (OR 0.85, CI 0.79-0.92, p < 0.001). Ninety-day mortality was also associated with: surgical volume, region, year, age, sex, and race, among other covariates. Interaction testing between these covariates was negative.

INTERPRETATION: Patients who underwent resection for early-stage NSCLC at facilities with higher SBRT utilization had lower rates of post-operative mortality. These findings suggest that the availability and utilization of SBRT may improve the selection of patients for surgery who are predicted to be at a high-risk for post-operative mortality.